Aortic stenosis increases afterload creating hypertrophy as a compensation mechanism to maintain minute volume. This leads to left ventricular diastolic dysfunction (LVDD). More than half of patients presenting aortic stenosis have LVDD and myocardial fibrosis, which is a mortality predictor in surgery. At present, there is contradicting evidence in TAVR. The study looked...
Courtesy of Dr. Carlos Fava. The current recommendation for aortic valve replacement is based on stenosis severity based on valvular criteria (mean transvalvular gradient, peak aortic velocity and valve index area) and the presence of symptoms, in addition to comorbidities, mainly for risk stratification. However, ventricular damage and/or its effect on cardiovascular hemodynamics are not regarded...
Courtesy of Dr. Carlos Fava. Transcatheter mitral valve repair with MitraClip has shown good results in symptomatic patients with extreme surgical risk in different studies. However, its “real world” benefits have not been studied in depth due to how complex this strategy is compared with other usual procedures. This study analyzed 2952 patients who underwent mitral...
Courtesy of SBHCI. Two new transcatheter treatments for severe or massive functional tricuspid regurgitation have showed good results at 30 days, according to their feasibility studies. The long-forgotten tricuspid valve has been gaining more attention with research linking tricuspid regurgitation to an increase in mortality. Early studies used devices originally designed for the mitral or...
Tricuspid regurgitation is frequent and mostly secondary to right ventricle and tricuspid annulus dilation. Tricuspid regurgitation has been associated to mortality increase, even though historically the importance of this valve has been disregarded compared to the other three. Tricuspid surgical repair has seen good results, but it is mostly done in the context of another valve repair. Isolated...
Courtesy of Dr. Agustín Vecchia. In the last few years, new percutaneous treatment options for mitral regurgitation have emerged. Transcatheter mitral annuloplasty with various devices is a relatively simple procedure that could compress the origin of circumflex artery branches due to the different orientation of mitral corners and the coronary sinus. The following work by Park...
Percutaneous coronary intervention (PCI) with drug coated balloons (DCB) is a viable alternative, especially in patients at high risk of bleeding, side-branch lesions in coronary bifurcation, or in small coronary segments. De novo heart disease treated with DCB has been shown non-inferior to conventional DES stenting, according to the PICCOLETO-II trial. However, these interventions are...
Timely percutaneous intervention of STEMI patients effectively reduces MI size and mortality, which currently makes it the first line of treatment. A fundamental aspect is activation and platelet aggregation, which is why, in addition to creating networks to optimize STEMI treatment, prehospital drug treatments have been implemented. The COMPARECrush looked at whether early and powerful...
Bicuspid aortic valve (BAV) disease affects 1%-2% of the population and manifests with severe aortic stenosis in the middle-aged. It characterizes for a very different anatomy with more calcification than the tricuspid aortic valve. At present, surgical aortic valve replacement (SAVR) is the first treatment indication. TAVR in this scenario has shown, in different studies,...
The edge-to-edge approach with MitraClip has been established as a valid strategy for patients who experience severe symptomatic mitral regurgitation (MI) with high risk for surgery, currently with a IIa indication. MI complicated by cardiogenic shock, which results in a high risk for conventional valve surgery, is a particularly complex scenario. In such a case,...